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1MB Cardiovascular > Cardiovascular Conditions > Flashcards

Cardiovascular Conditions Flashcards

1
Q

What is atherosclerosis?

A

A combination of atheromas (fatty deposits in artery walls) and sclerosis (the process of hardening or stiffening of the blood vessel walls) affecting medium and large arteries.

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2
Q

What causes atherosclerosis?

A

Chronic inflammation and activation of the immune system in the arteries wall causing deposition of lipids the the artery wall.

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3
Q

Atherosclerosis Risk Factors

A 
Old Age
Family History
Male
Smoking
High alcohol consumption
Poor Diet
Low Exercise
Obesity
Poor Sleep
Stress
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4
Q

Medical Co-morbidities Associated

A 
Diabetes
Hypertension
Chronic Kidney Disease
Rheumatoid Arthritis
Atypical Antipsychotic Medications
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5
Q

What is aortic regurgitation?

A

a condition in which there is inadequate closure of the aortic valve during cardiac diastole, leading to the leakage of blood from the aorta into the left ventricle

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6
Q

Signs and Symptoms of Aortic Regurgitation

A 
Exertional Dyspnoea
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Angina
Peripheral oedema
Fainting
Heart Murmur (soft, high-pitched, early diastolic decrescendo murmur)
Tachycardia
Palpitations
Tachypnoea
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7
Q

Causes of aortic regurgitation

A

issues with the supporting structures of the aortic root (e.g., aortic root dilation) or inadequate closure of the aortic valve leaflets during diastole(e.g., aortic root calcification). This can be either due to an impairment of the leaflets, or an increased afterload e.g., hypertension

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8
Q

Diagnosis of aortic regurgitation?

A

Echocardiogram - shows dilation of left ventricle. decreased ejection fraction and adequate systolic ejection
CXR - enlarged heart due to left ventricular hypertrophy
ECG - hypertrophy

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9
Q

Treatment of aortic regurgitation?

A

Pharmacological:
ACE inhibitors (Ramipril) and calcium channel blockers (amlodipine) to reduce afterload and relieve symptoms.
Surgery - aortic valve replacement

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10
Q

Complication of aortic regurgitation

A

Congestive heart failure if left untreated

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11
Q

What is cardiomegaly?

A

the abnormal enlargement of the entire heart, one side of the heart or a specific area (atrium or ventricles). Usually indicative of an underlying health problem

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12
Q

Causes of cardiomegaly?

A

Conditions making the heart work harder - (high blood pressure, pulmonary hypertension)
Conditions damaging heart muscle (pericarditis or coronary artery disease)
Others which cause more stress on the heart - anaemia, hypothyroidism, hyperthyroidism

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13
Q

Signs and Symptoms of cardiomegaly?

A 
Shortness of breath
Fatigue
Abnormal Rhythm
Chest pain
Peripheral oedema
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14
Q

Diagnosis of cardiomegaly?

A

CXR - shows enlarged heart
Echocardiogram and ECG used to help find the cause
Blood tests

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15
Q

Non-Pharmacological treatments for cardiomegaly?

A

Lifestyle modifications to decrease risk factors such as smoking cessation, healthy diet, increase exercise, decreasing alcohol consumption

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16
Q

Pharmacological treatment for cardiomegaly?

A 
Statins to reduce cholesterol (Coronary Artery Disease) and aspirin
ACE inhibitors (high blood pressure)
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17
Q

Complications of cardiomegaly?

A

Blood clots and heart failure

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18
Q

What is Deep Vein Thrombosis (DVT)?

A

when a blood clot, or thrombus, develops in one of the large veins of the upper or lower limbs

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19
Q

Causes of DVTs?

A

Virchow’s triad, which includes hypercoagulability, slowed venous blood flow, and damage to the inner lining of blood vessels.
Hypercoagulability - due to genetic conditions, such as with factor V Leiden or with antithrombin III deficiency, or due to acquired reasons, such as after a surgery or when taking certain medications
Slowed venous blood flow - can happen during long periods of inactivity, such as with prolonged bed rest, long flights and car rides, and during pregnancy
Damage to vessels - caused by some kind of trauma or injury; atherosclerosis; infections; chronic inflammation; or toxins, like those found in tobacco cigarettes

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20
Q

Signs and Symptoms of DVT?

A

Redness
Swelling
Pain in affected limb

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21
Q

Diagnosis of DVT?

A

D-dimer blood test
Physical Examination
Wells Score

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22
Q

Treatment of DVT?

A

Blood thinners e.g., heparin, warfarin or direct anticoagulants e.g., rivaroxaban

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23
Q

Prevention of DVT?

A

Compression stockings and doing frequent calf exercises

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24
Q

Complications of DVT?

A

Pulmonary Embolism

Venous thromboembolism

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25
Q

What is unstable angina?

A

A type of angina pectoris that is unpredictable and classified as an acute coronary syndrome

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26
Q

Causes of unstable angina

A

Usually caused by ruptured atherosclerotic plaque or formation of thrombosis on top of plaque causing almost complete blockage of blood vessel

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27
Q

Signs and symptoms of unstable angina

A

Pain characterised as a pressure, squeezing, burning and tightness radiating to jaw, arms, shoulder and back which lasts for no more than 20 minutes
Dyspnea
Fatigue
Nausea

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28
Q

Diagnosis of unstable angina

A

Serial troponins measured to rule out MI

ECG can present with ST segment depression and T wave inversions

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29
Q

Treatment of unstable angina

A

Clopidogrel, low molecular weight heparin (LMWH), Enoxaparin

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30
Q

What is a myocardial infarction?

A

Death of heart muscle cells due to lack of oxygen rich blood flow

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31
Q

Causes of MI

A

Plaque buildup forming in the lumen

Blood platelets adhere to plaque and enhance clotting process, creating a blockage

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32
Q

Types of MI

A

STEMI - coronadt artery completely blocked. ECG shows ST elevation, possible Q waves
NSTEMI - coronary artery not completely blocked. ECG shows ST depression

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33
Q

Risk factors for MI

A 
Old age
Smoking
High blood pressure
Diabtetes
High cholesterol
Low levels of exercise
Obesity
Alcohol consumption 
Illegal drug use
Chronic stress
Family history
Male
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34
Q

Complications of MI

A 
DARTH VADER
Death
Arrythmia
Rupture
Tamponade
Heart Failure
Valve disease
Aneurysm of ventricles
Dressler’s syndrome
Embolism
Recurrence/Regurgitation
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35
Q

Signs and Symptoms of MI

A 
Acute chest pain radiating to arm/jaw
Feeling of fullness/indigestion 
Dyspnea
Fatigue
Nausea
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36
Q

Diagnosis of MI

A

Troponin - rise apparent within 2-4hrs, peaking ~24hrs
CK-MB - detects reinfarction after initial MI - levels increased 4 hrs after infarction
ECG:
<30 mins - ST segment elevation (STEMI) or ST depression (NSTEMI)
<24hrs - T wave inversion
>24hrs - Q waves appear

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37
Q

Treatment of MI

A

Percutaneous Coronary Intervention (PCI)
NSTEMI less time sensotive than STEMI
Control symptoms with morphine and nitroglycerin
Heparin, aspirin + clopidogrel, beta blockers, ACE Inhibitors, statins

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38
Q

What is peripheral artery disease?

A

Narrowing of the arteries in peripheral, non-coronary arterial circulation. Decreased blood flow causes arterial insufficiency which leads to tissue ischaemia

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39
Q

Risk factors for peripheral arterial disease

A 
Smoking
High BP
Diabetes
Hyperlipidaemia
Metabolic syndrome
Age>60
Obesity
Increased risk in people of African descent
40
Q

Complications of peripheral artery disease

A

Pain
Tissue necrosis
Amputation
Increased risk of developing coronary artery disease

41
Q

Signs and symptoms of peripheral artery disease

A

Asymptomatic until significant occlusion develops
Intermittent claudication - muscle pain due to increased oxygen demand and decreased supply
Decreased peripheral pulses
Leg/foot ulcers that do not heal properly
Colour changes
Cool dry shiny hairless skin

42
Q

Signs of acute limb ischaemia

A 
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
43
Q

Diagnosis of peripheral artery disease

A

Doppler ultrasound - decreased blood flow

Auscultation- bruit heard in suspected artery

44
Q

Treatment of peripheral artery disease

A

Antiplatelet therapy
Surgery - angioplasty, stent insertion, bypass surgery, amputation
Modify risk factors
Wound care

45
Q

What is aortic dissection?

A

Tearing/widening of artery’s internal layer followed by blood entering vessel wall causing pain

46
Q

Types of aortic dissection

A

Type A : dissection involves ascending aorta and/or aortic arch, sometimes descending aorta
Type B: dissection involves descending aorta/aortic arch without involvement of ascending aorta

47
Q

Causes of aortic dissection

A

Weakness in vessel wall due to chronic hypertension, blood vessel coarctation, connective tissue disorders, aneurysms

48
Q

Risk factors of aortic dissection

A 
Pregnancy
Previous open heart surgery
Vasculitis
Trauma
Family history
Turner’s syndrome
Cocaine use
49
Q

Complications of Aortic Dissection

A

Pericardial tamponade

Obstruction of arterial branches off aorta leading to ischaemia of individual organs

50
Q

Signs and symptoms of aortic dissection

A 
Sudden, intense, tearing chest pain radiating to back
Nausea
Vomiting
Decreased peripheral pulses
Asymmetric pulses 
Diastolic decrescendo murmur
51
Q

Diagnosis of aortic dissection

A

CXR - widening of mediastinum
Transesophageal echocardiogram- high sensitivity for identifying dissection and complications
CT angiography
ECG - Helps rule out alternative diagnostic possibilities

52
Q

Treatment of aortic dissection (Medications)

A

First line - beta blockers
Second line - calcium channel blockers
Pain management
Surgical repair if necessary

53
Q

What is vasculitis?

A

Inflammation of blood vessels

54
Q

Causes of vasculitis?

A

Damaged endothelium

Autoimmune disease

55
Q

Signs and symptoms of vasculitis

A 
Fever
Weight loss
Malaise
Fatigue
Ischaemia - blood cells clump together and fibrin deposits in vessel wall restrict blood flow
56
Q

Diagnosis of vasculitis

A

C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
Complete blood count
Biopsy vessel segment

57
Q

Treatment of vasculitis

A

Corticosteroids/immunosuppressive drugs to reduce inflammatory response

58
Q

What is hypertension?

A

Condition in which blood pressure not regulated correctly resulting in elevated blood pressure over 140/90mmHg

59
Q

Types of hypertension

A

Primary hypertension

Secondary hypertension - due to other conditions

60
Q

Risk Factors of primary hypertension

A 
Age
Male
Obesity
Stress
Sedentary lifestyle
Family history
Excess sodium and alcohol intake
High cholesterol
61
Q

Complications of hypertension

A 
Increased risk of atherosclerosis 
Loss of arterioles
Coronary artery disease
Left ventricular hypertrophy
Atrial fibrillation 
Stroke
Retinopathy 
Aortic dissection
62
Q

Signs and symptoms of hypertension

A

Vast majority are asymptomatic
Headaches
Dyspnea

63
Q

Diagnosis of hypertension

A

Non-invasive blood pressure monitoring

64
Q

Treatment of blood pressure (non pharmacological)

A 
Low sodium diet
Exercise
Quit smoking
Limit alcohol
Maintain healthy weight
65
Q

Pharmacological Treatment for patients aged 55 or over or african caribbean descent

A

Calcium Channel Blocker e.g., amlodipine
Then ACEI or ARB
Then thiazide like diuretic
Then low dose spironolactone or beta blocker

66
Q

Pharmacological treatment of patients with type 2 diabetes or aged under 55

A

ACEI or ARB
Then CCB
Then thiazide like diuretics
Then low dose spironolactone or beta blocker

67
Q

What is familial hypercholesterolemia?

A

Autosomal dominant disorder that causes increased LDL leading to early onset atherosclerotic disease

68
Q

What is hyperlipidemia?

A

Increased serum total cholesterol and LDL

69
Q

Causes of hyperlipidemia?

A

Primary - genetic abnormalities or defective apoprotein B

Secondary - Cushing Syndrome, excessive alcohol intake, uncontrolled diabetes mellitus, certain drugs

70
Q

Risk Factors of hyperlipidemia

A

Genetic predisposition
Diet/other lifestyle factors
Pregnancy
Male

71
Q

Complications of hyperlipidemia

A

Cardiovascular disease
Cerebrovascular disease
Peripheral vascular disease

72
Q

Signs and symptoms of hyperlipidemia

A

Corneal arcus

Xanthomas

73
Q

Diagnosis of hyperlipideamia

A

Physical examination - presence of risk factors and cardiovascular disease symptoms
Fasting lipid profile - increased total cholesterol, increased triglycerides, increased LDL and decreased HDL

74
Q

Treatment of hyperlipidemia

A

Statin therapy

75
Q

What is atrial fibrillation?

A

Rapid, irregular heart rate

76
Q

Causes

A

Regular impulses of sinus node overwhelmed by rapid electrical discharges from various sources

77
Q

Risk Factors of atrial fibrillation

A 
Old age
Obesity
Diabetes
Excessive alcohol consumption 
Coronary artery disease 
Cardiovascular disease
Lung disease
Hyperthyroidism
78
Q

Complications of atrial fibrillation

A

Thromboembolic events
Heart failure
Hypotensive shock
Stroke

79
Q

Signs and symptoms of atrial fibrillation

A 
May be asymptomatic 
Dyspnea
Fatigue
Palpatations
Lightheadedness
Weakness
Chest pain
80
Q

Diagnosis of atrial fibrillation

A

ECG - absent P waves, irregularly timed QRS complexes

Echocardiogram

81
Q

Rate control of atrial fibrillation

A

Beta blockers
Non-dihydropyridine calcium channel blockers
Digoxin

82
Q

Rhythm control of atrial fibrillation

A

Restore sinus rhythm through cardioversion

83
Q

Other medications for atrial fibrillation

A

Anticoagulants e.g., warfarin, rivaroxaban

84
Q

What is long QT syndrome?

A

Cardiac rhythm disorder characterised by prolonged ventricular repolarisation

85
Q

Types of long QT syndrome

A

Inherited - caused by mutations in genes associated with cardiac potassium, sodium channels.
Acquired - usually caused by certain drugs

86
Q

Risk factors for long QT syndrome

A 
Electrolyte imbalances
Underlying heart disease
Bradyarrhythmias
Biological females
Old age
Inherited genetic mutation
Anorexia 
Postpartum period
87
Q

Complications of long QT syndrome

A

Palpatations
Lightheadedness
Hypotension

88
Q

Diagnosis of long QT syndrome

A

Serum electrolytes - hypokalemia, hypomagnesemia, hypocalcemia
ECG - prolonged QT, altered T-Wave
Exercise stress test
Genetic testing

89
Q

Treatment for long QT syndrome (medications)

A

Congenital - beta blockers, mexiletine, flecainide

Acquired - magnesium sulfate, isoproterenol, lidocaine

90
Q

Treatment for long QT syndrome (surgery)

A

Congenital - implantable cardioverter-defibrillator, pacemaker
Acquired - pacemaker if bradycardia triggers arrhythmia

91
Q

What is torsades des pointes (TdP)

A

Where the peaks of QRS complex twist around isoelectric line on electrocardiogram

92
Q

Risk factors of Torsades des pointes

A 
LQTS 
Bradycardia
Electrolyte imbalance
Female
Anorexia
93
Q

Complications of tosades des pointes

A

Ventricular fibrillation
Seizures
Sudden cardiac death

94
Q

Signs and symptoms of torsades des pointes

A

Palpatations
Lightheadedness
Syncope

95
Q

Diagnosis of torsades des pointes

A

Serum electrolytes

ECG - PR interval irregular, P wave absent, QRS duration >0.12 seconds

96
Q

Treatment of torsades des pointes

A

Medications - magnesium sulfate or beta blockers
Surgery - left cardio-thoracic sympathectomy
Treat underlying cause

1MB Cardiovascular (4 decks)

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